Medicare is like most health insurance carriers in that they provide benefits for services that will improve your health or quality of life. Two services that fall under this realm are speech-language therapy and occupational therapy as they help you handle day to day stresses and frustrations. These benefits will help you incur the financial strain involved with getting therapy.
Medicare defines these services as follows: “…Speech-language therapy (pathology services) includes exercise to regain and strengthen speech skills. Occupational therapy includes exercise to help you do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and perform other usual daily activities. You may continue to receive occupational therapy if ordered by your doctor even if you no longer need other skilled care…”
If you feel that you qualify for these services you should talk to your doctor or another medical professional as soon as possible. You could be paying for services that are covered under the Medicare policy that you have and are paying premiums for. Ask your doctor specifically if you qualify for these services and make a point of telling him or her that you think this could improve your quality of life. Don’t quit trying to get the services that you are contractually able to receive.
Medicare has about as many twists and turns as a road in the Rocky Mountains and this causes a lot of facts to fall through the cracks. Instead of waiting for a time to cover everything about certain services in a separate article we decided to throw a few random things into one group. Here are a few random things you may or may not know about Medicare Part B: Read more…
There is an endless amount of ways that you can get in to financial trouble trying to pay your insurance premiums, one being paying for prescription drugs. In the past there was no relief for anyone hitting the coverage gap known as the donut hole, you hit it and you were out money. For this year only there is help for you and if you have hit the coverage gap you will be receiving a $250 payment in no time. Read more…
Being diagnosed as a diabetic is not a fun moment for anyone that has the unfortunate experience in their life. You must change your entire life to treat the condition and it becomes a very difficult situation to overcome in your existence. However, with the help of your Medicare insurance you can get help with your diabetes and live a better life.
If you are not familiar with Diabetes Self-Management Training it is an amazing training experience that will help you deal with your lifestyle. The course includes education about self-monitoring of your blood glucose as well as your diet and exercise. On top of that you have the opportunity to learn a little more about the insulin that becomes so important to your life.
The very question in and of itself is terrifying and very grim, but the question has been asked by many a Medicare patient, is the blood I need covered? Many people don’t realize that some of your Medicare Part A coverage may kick in when this situation arises. If you are in the situation that you need blood don’t wait on your insurance to decide if it will be covered or not. Read more…
The Obama Healthcare Plan has been in the news for the last couple of years now and it is even more pressing news as the plan is so close to being in force. Many people are aware of the effects that the plan will have on the private insurance companies in the country, but how will it affect Medicare benefits? Are there changes that could happen soon to Medicare benefits that Medicare beneficiaries should know about?
One of the biggest and possibly soonest changes under the new healthcare plan to Medicare benefits is the free checkups and screenings. This is part of Obama’s changes that he wants in force next year and it would entitle all beneficiaries, even if they do not change insurance plans, to get a free annual checkup and free screening. These changes would benefit thousands or possibly millions of Medicare beneficiaries across the country.
The free screenings could include preventative measures such as colonoscopies and mammograms, which would be a relief to many. These changes to Medicare benefits have not been made or put in force yet, but the final steps are being walked in Washington right now. Be sure to check back for other possible changes to Medicare benefits with the new healthcare plan.
Medicare Part B will help you cover yourself in the event that you need services to help detect or treat a major medical illness. With Medicare Part B there are some services that are covered directly while others are covered in part by Medicare and the rest is left to you. There are some tests for Colorectal Cancer that are covered by Medicare Part B and they are outlined below.
Again, if you think you are going to have to use Medicare Part B for any of the above you should always consult your doctor first.
Medicare Part D is what assists you in paying for your prescription drugs and the Federal Government realizes that this process may be more expensive for some than others. If you are someone who requires a lot of prescription drugs and Medicare Part D alone doesn’t seem to give you enough, it is time to consider the “Extra Help” program. Qualification for Medicare Part D Extra Help is not easy for everyone, but you may have an automatic qualifier.
Here are three ways that you may qualify for Medicare Part D Extra Help. You only have to be able to answer yes to one of these questions.
If you qualify based on one or more of the preceding points then you could get Medicare Part D Extra Help to give you a little more assistance. Understand that there are other possible income requirements, but being a part of one of the above groups will likely include you in those requirements as well.
When you are enrolling in your Medicare benefits it is always good to know what you can and cannot get from a particular coverage, such as Medicare Part A. Medicare Part A generally has to do with hospital insurance and similar things related to a hospital stay being covered. However, it is not just beneficial to know what is covered, it will help you to know what is not covered by Medicare Part A.
Medicare Part A does not cover the following:
•Private duty nursing is not covered and should not be considered a part Medicare Part A. This will likely have to be covered by personal funding.
•A television or telephone in your room or personal care items like razors or slipper socks will not be covered by Medicare Part A. Make sure you have someone that can bring you these things while you are in the hospital.
•A private room unless medically necessary will not be covered by Medicare Part A. This is viewed as being an extra benefit not a necessity.
•The first three pints of blood unless the blood deductible has been met will not be covered by Medicare Part A. This is good to know if you have already paid your deductible for the year.
The doctor services you get while you are in a hospital may be filed under Part B. Don’t forget that some of the above may also be covered under other parts of Medicare, but not under Medicare Part A.
Insurance is costly enough if you simply have to pay the premiums that come along every month, but what about the costs that aren’t included with Medicare benefits? The out-of-pocket costs that aren’t discussed freely are usually where you start to lose your tie when trying to pay for medical bills. Medicare benefits are similar to all other forms of insurance in that some things you have to take care of independently.
How to decide if you will pay out-of-pocket with Medicare benefits:
In short, the message is this, the more research you do during enrollment the more of a chance you have to pay lower out-of-pocket costs. Medicare benefits can only take you as far as you allow them to.
Medicare is nothing if not difficult to understand and constantly changing so it is always worth it to you to stay up to date on the changes every year to Medicare benefits. One of the new Medicare benefits for 2010 is the addition of “Mental Health Care” to individuals who are struggling with such things as depression, anxiety and substance abuse.
This new addition to Medicare benefits will assist you financially in taking care of the tab when you visit a doctor, psychiatrist or social worker to treat your mental health condition. If you are diagnosed and being treated for your mental health condition then this Medicare benefit will cover more than if you are not.
When you are going to a doctor to be diagnosed for a mental health condition then this Medicare benefit will pay 20% of the amount that is approved by Medicare. This same 20% applies to the Medicare benefit when you monitor or change your prescription that treats your mental health condition.
If you are receiving treatment for your mental health condition, such as trips to see a therapist or going through therapy then you will pay 45% of the Medicare approved amount under this Medicare benefit. This amount will decrease over a 4 year period as part of your Medicare Part B deductible.
It is that time of year again, the time of the year dreaded by adults worldwide, it is the time to enroll in your medical/health plan for next year. This is no different for those who are on Medicare, who must prepare fully for the next year just like anyone else. For those who may be new to the process or those who have forgotten, here is a quick Medicare benefits refresher.
Medicare Benefits Part A: This coverage is provided at no cost to those who qualify, no cost in reference to a monthly premium, though in 2009 the deductible for the year is $1,100. This is for hospitalizations for the individual listed on the plan.
Medicare Benefits Part B: This coverage is provided to those who qualify at an average of $96.40 per month with a deductible this year of $155. This is to cover the cost of doctor visits or visits to other healthcare professionals.
Medicare Benefits Part C:Â Individuals that enroll in this coverage do so to lower the out-of-pocket costs by using the Medicare Advantage Network for fee-for-service plans.
Medicare Benefits Part D: This coverage is provided to those who qualify for $31.94 per month with an annual deductible of $310. This is the only stand alone drug plan offered to seniors, without this plan seniors are responsible for 100% of their drug costs.
Enrolling in Medicare is an excellent way to ensure you are able to receive the vital health care you may need. However, not all medical supplies and services will be covered by your Medicare Parts A and B. In order to best prepare for your future, it is essential to be aware of some important coverage limitations.
For instance, Medicare doesn’t cover acupuncture, cosmetic surgery, hearing aids, hearing aid-fitting exams, and hearing tests (unless ordered by your doctor). Medicare also won’t cover custodial care, unless you are also receiving skilled nursing care in a nursing facility, in a hospice, or at home. The majority of chiropractic services also aren’t covered, other than for subluxation. Aside from a few exceptions, most dental care, dentures, foot care, orthopedic shoes, and eye-glasses won’t be covered either.
Although Medicare does cover a “welcome to Medicare” physical exam when you first enroll, yearly or routine exams aren’t generally covered. Additionally, many vaccines and prescription drugs, as well as syringes or insulin not used with an insulin pump, won’t be covered by Parts A and B. If you plan to travel, be aware that most medical care won’t be covered by Medicare if you’re traveling outside of the United States.
There are, of course, many valuable services which are covered by your Medicare Parts A and B. Even when services are covered, though, you may be responsible for paying deductibles, coinsurance, or copayments for a number of these services. By being cognizant of coverage limitations in services and supplies, you will be better able to plan, financially and practically, for your health care needs.
Medicare Part A is the component of your Medicare insurance that deals with Hospital Insurance. For most people, there is no monthly premium for Medicare Part A, as long as you or your spouse have paid enough Medicare taxes while working. However, while you usually don’t need to pay monthly premiums for Part A, many services will involve some out-of-pocket costs.
Receiving blood in the Original Medicare Plan, for example, will require you to pay for the first 3 pints you get as an inpatient. After that, you will be responsible for 20% of the Medicare-approved amount. An exception to this cost is if you or someone else donates enough blood to replace the blood you received.
For home health care, you pay nothing for the home health care services and 20% of the Medicare-approved amount for necessary durable medical equipment. For hospice care, you will need to cover a copayment of up to $5.00 per prescription for outpatient prescription drugs, as well as 5% of the Medicare-approved amount for inpatient respite care. Also, if you receive hospice care somewhere other than for short-term general inpatient/respite care, you might be responsible for the cost of room and board.
In the case of hospital stays, you will need to pay a $1024 deductible and $0 coinsurance for 1 – 60 days each benefit period. For days 61 – 90 each benefit period, you will cover $256. Following day 90 for each benefit period (for up to 60 days over your lifetime), you will pay $512 per lifetime reserve day.
For skilled nursing facility stays, you will pay nothing for the first 20 days each benefit period, and $128 per day for days 21 – 100. After that, you will be responsible for all costs incurred.
Medicare Advantage Plans will cover the same benefits as your Original Medicare, but costs won’t necessarily be the same. For details on specific out-of-pocket costs, contact your plan directly.
All Medicare Prescription Drug plans have a number of rules, created to meet the needs of beneficiaries and, at the same time, to protect plan providers.
One of the rules for most Medicare drug plans is that they need to cover two drugs, minimally, in each drug category. They also need to cover almost all drugs in the anit-psychotics, anit-depressants, anti-convulsants, immunosuppressants, cancer, and HIV/AIDS classes. Additionally, even when a Medicare drug plan doesn’t have a certain drug on its formulary, another drug with a comparable function which is equally effective will likely be covered.
The plans are usually able to choose which of the drugs in each category they will cover. There are also a number of drugs your plan probably won’t cover, like barbiturates, benzodiazepines, and weight control drugs, although some plans may. Most often, your drug plan won’t cover over-the-counter medication. There are, of course, exceptions, like if your state allows people with Medicaid to receive coverage for these over-the-counter drugs.
Plans must, regardless of which Medicare Prescription Drug plan you are enrolled in, have some sort of a process which allows you to request coverage for a necessary drug not included in their formulary.
Drug plans also have some stipulations to ensure correct coverage use, such as you and/or your doctor needing to contact the plan prior to prescription coverage, demonstration of the medical necessity of the drug, a limit on how many drugs you can get at once, and “step therapy”, which is trying one or more similar, low-cost drug before moving on to a more expensive brand-name version.
Because formularies vary according to plan and because they may change, each plan will have the required up-to-date information you need. To find out what drugs are covered by your Medicare Drug Plan, contact your plan directly.
The Flu Shot is covered each flu season for all beneficiaries in a Medicare program. It is given once a year, either in the fall or in the winter, and is an important factor in staying healthy.
The flu, or influenza, is a contagious infection which is commonly spread though coughing, sneezing, or direct contact. It can cause a number of symptoms, ranging from congestion and a sore throat, to muscle pain and fatigue, to fever and chills, to, albeit rarely, nausea and diarrhea. Some people will have only a few symptoms, others will have many.
Although the flu shot won’t necessarily prevent you from getting the flu, your symptoms will likely be milder if you’ve had your vaccine. It’s a good idea to get your shot between September and November, since December is when the flu begins to gain prominence. However, because flu season is considered to be from November to April, you should get your flu shot even if you missed the fall vaccination.
In addition to getting a flu shot, you can take other steps to help prevent the spread of influenza. Wash your hands often, with soap and water. Try not to frequently touch your mouth or nose. If possible, try not to be in close contact with others who have the flu. If you are sick yourself, stay home from work and keep your distance from people, when possible. Also, make sure you cover your mouth when coughing or sneezing.
Medicare covers a number of essential preventive services, including the Flu Shot. Make the most out of your coverage: remember to get your flu shot each year.
The Recovery Audit Contractor demonstration program was created to study whether or not using Recovery Audit Contractors is a productive way to make sure correct payments are being made by Medicare to providers, and whether or not this method will save Medicare money and further protect the Medicare Trust Fund.
Recovery Audit Contractors, or RAC, are companies hired by Medicare to find incorrect payments made by Medicare to health care providers and suppliers. Incorrect payments can, of course, come in a number of forms, including claims erroneously submitted and paid twice as well as, sometimes, underpayments by Medicare. The RAC program will catch and correct both, although it is ultimately intended to help Medicare by recovering money lost by overpayments.
While you may get your money back if a RAC review finds you personally overpaid, the Recovery Audit Contractor Program will not put any other money directly back into your pockets. Even if RAC companies are able to recover lost funds for Medicare, this money won’t be shared directly with beneficiaries. Your Medicare benefits also will not change due to the RAC program.
However, the RAC program does benefit you indirectly. For instance, it saves taxpayer dollars. It also protects the Medicare Trust Funds, which will help future generations as well.
Currently, the Medicare RAC program is in California, Florida, New York, Massachusetts, South Caroline, and Arizona. The Centers for Medicare & Medicaid Services expect RAC to be in use throughout the country by 2010.
The Centers for Medicare and Medicaid Services provide an online resource intended to help you make informed choices about your health care. The resource, called Hospital Compare, offers a variety of specific information in order to give you a complete picture of hospitals throughout the country.
The Hospital Compare site allows you to compare hospitals in a number of different ways. For instance, it will enable you to see, using survey information, how patients feel about their hospital experiences. Some topics include pain management, overall quality of care, and staff communication with patients.
The site also lets you look at how mortality rates for different conditions compare with the national death rates for these same conditions, and how often hospitals treat recommended heart attacks, heart failure, pneumonia, and surgery.
You can compare hospitals in terms of how many people with Medicare have had various treatments. You can even see what Medicare usually pays a hospital when it performs certain procedures.
In addition, you may use the Hospital Compare site to figure out which hospitals are accredited. The Hospital Compare site will also provide information on your rights as a patient and how to report a quality complaint. It can direct to you other relevant publications or websites.
By using the Hospital Compare resource, you will be able to make an educated decision regarding which hospitals will likely offer you the highest quality of care. You can find this valuable tool at www.medicare.gov/hospital.
Programs of All-inclusive Care for the Elderly, otherwise known as PACE, are Medicare programs for individuals over 55 who have disabilities. PACE provides alternatives to nursing-home care, and, through a variety of services, works to offer beneficiaries with options to remain living in their community. You are eligible for PACE if you are 55 years or older, live in a PACE organization service area, are certified by your state as needing nursing home level of care, and are able to, with the help of PACE, safely reside in your community when you join.
To create an individualized health care plan, PACE uses a team of skilled professionals, experienced in working with the elderly. This health care team will work with you to determine the type of care and services you will require to have your health needs met.
PACE covers a wide variety of services, in addition to those covered by Medicare and Medicaid. Some of their coverage benefits may include prescription medication, hospital visits, check-ups, doctor care, home care, emergency services, transportation, necessary nursing home stays, adult day care, recreational therapy, social services, dentist care, nutritional counseling, and X-ray services. There are a number of other services that may be covered as well, depending on your needs.
Enrollment in PACE is does not depend on your financial situation. If you qualify for Medicare, all Medicare-covered services will be paid for. The long-term care offered by PACE will also be covered, either fully or with a minimal monthly payment, if you qualify for your State’s Medicaid Program. If you don’t, you will need to pay a monthly premium for PACE benefits and Medicare Prescription Drug coverage, although you won’t need to pay any deductibles or copayments for services approved by your team.
PACE is one way Medicare can meet your needs. For more information, visit the National PACE Association at www.npaonline.org.
If you or someone you love needs regular dialysis, uniform information about available dialysis facilities is invaluable. It’s important to be able to compare your options and to be aware of the quality of care at the facilities you consider.
Fortunately, Medicare provides an easy, effective way for you to compare dialysis facilities through their website, with their “Dialysis Facility Compare Tool”. This tool allows users to access valuable information about specific dialysis treatment facilities. The tool provides basic information about the facility name, address, and telephone number. It also offers the date Medicare certified the facility, shifts beginning at or after 5:00pm, the number of hemodialysis treatment stations, the types of dialysis available, the organization that owns/manages the facility, and whether or not the facility is non-profit. In terms of quality measures, you can find out the percentage of patients at specific facilities who got adequate hemodialysis, who were treated for anemia, and whose anemia was adequately managed. You can find out patient survival information and, ultimately, how well the facility treats its patients.
The compare tool will allow you to search for dialysis facilities by name, city, ZIP code, state, or country. Once you select some facilities you would like to compare, you will have access to the dialysis facility services and quality information. You will also be given contact information for local ESRD Networks and State Survey Agencies, which you can use to get more information about dialysis.
The compare tool will also provide additional resources, such as informational pamphlets, answers to frequently asked questions, definitions of relevant terms, information on complaint procedures, information on patient rights, a patient checklist, and links to other related websites.
You can access Medicare’s Dialysis Facility Compare tool at www.medicare.gov.
If you are enrolled in a Medicare plan, you automatically have a number of rights. One of the most essential rights is the right to appeal. The right to appeal (a complaint you make when you disagree with a decision made by your Medicare plan), is guaranteed to all Medicare recipients.
Some conditions under which you may choose to file an appeal are, for instance, if you are denied coverage for care you’ve already received, if you are denied a request for a service, supply, or prescription (or if it is not covered and you think it should be), or if your plan stops paying for a service you are currently getting coverage for.
If you decide to file an appeal, how to proceed depends on what type of plan you are enrolled in. Medicare Advantage Plans and Prescription Drug Plans have specific procedures in place to allow you to use the appeal process. They should include this information in the materials you receive from them. Similarly, Original Medicare also has specific procedures in appealing a decision.
The first step in the Original Medicare Plan is to obtain the Medicare Summary Notice where the service you are appealing appears. Next, you need to circle the item to which you object. You then need to explain, in written form, why you disagree. You will want to write this explanation on the MSN. Include your telephone number and signature. Finally, send it (or a copy) to the address in the “Appeals Information” section of the MSN. You need to file this appeal within 120 days of when you receive the MSN.
It’s essential, when considering filing an appeal, to follow the instructions on your MSN. There are also a number of resources to help you with this process. Call your State Health Insurance Assistance Program for more information, or 1-800-MEDICARE.
Medicare provides health insurance for people 65 and over, people under 65 with specific disabilities, and people of any age with End-Stage Renal Disease. Both Medicare Parts A and B are required to provide ESRD Medicare recipients with coverage.
Typically, dialysis coverage begins the fourth month of your treatments. However, there are some circumstances which will allow you to receive earlier Medicare benefits. For instance, if you participate in a home dialysis training program to learn how to give yourself home dialysis treatments (before your fourth month of treatments), your coverage can begin the first month of dialysis, provided the training facility is approved by Medicare and that you expect to finish the training and give yourself dialysis treatments. You can receive coverage the same month you are admitted to a hospital (also approved by Medicare) for a kidney transplant or preparations for a kidney transplant, if your transplant is within that month or two months following it. If your transplant is postponed over two months after being admitted, your coverage can start two months before your transplant.
Although your coverage will end twelve months after the month you stop dialysis treatments and 36 months after the month of your kidney transplant, there are circumstances which will allow your benefits to be extended. If you get a kidney transplant 12 within months following the month when you stopped dialysis or 36 months following the month you have a kidney transplant, your benefits will be extended. They will also be extended if you start dialysis again in the same time frame.
If you or someone you love has End-Stage Renal Disease, look into your Medicare benefits. When you’re aware of your options, you will find that Medicare can help provide timely coverage for your health care needs.
Enrolling in a Medicare Prescription Drug Plan is an excellent way to ensure your continued health, and is often essential in providing a way for you to receive the medication you require. However, there are times when you may experience a gap in your Medicare drug coverage. In fact, most drug plans have some type of coverage gap. For instance, sometimes the gap is in the form of a financial limit. Other times, the gap is due to a lack of coverage for a specific type or brand of medication. Whatever the cause, finding yourself in a coverage gap can be costly. There are, however, a number of things you can do to reduce this financial burden.
One way to reduce your expenses is to switch to a generic version of your required medication. You may also be able to find brand name which is less-expensive than the one you currently use or use an over-the-counter variety. To explore your options, visit the Prescription Drug Plan Finder section at www.medicare.gov, or talk to your health care provider.
Another way to reduce costs is to look at programs offering financial assistance. There are a number of community based and national charitable programs that are designed to help people cover the cost of medication. You may also want to explore whether there are any State Pharmaceutical Assistance programs available in your area. Many drug manufacturers also offer assistance programs worth looking at. If you’d like additional information about assistance programs, there are a number of helpful online resources available. Visit http://www.benefitscheckup.org for a “Benefit Checkup” website, http://www.medicare.gov/pap/index.asp for “Pharmaceutical Assistance Programs”, and http://www.medicare.gov/spap.asp for the “State Pharmaceutical Assistance Program” site.
Finally, if you have limited income and are a Medicare recipient, you may be able to receive extra help covering your costs. To find out if you qualify, visit www.socialsecurity.gov, call them at 1-800-772-1213, or contact your State Health Insurance Assistance Program.
For terminally ill patients, Medicare’s hospice benefit can provide support, care, and rest. Hospice Care primarily includes medical and nursing care, therapy, medication for the terminal and related conditions, and durable medical equipment. Designed to allow quality-of-life for these patients, it doesn’t cover treatment to cure the terminal illness. However, regular Medicare benefits will continue to cover treatments unrelated to the disease.
A number of services are covered by Original Medicare’s Hospice Care coverage. The medical and support care include doctor’s services, skilled nursing, home health aide, and respite care. Medicare Hospice Care also covers physical therapy, speech-language therapy, occupational therapy, dietary counseling, and patient/family counseling. Drugs to control symptoms and provide pain relief are also included, as are wheelchairs, walkers, and wound dressings.
In order to be eligible for Medicare’s hospice benefit, recipients must have Medicare part A. Their doctor and a hospice medical director must certify that the recipient likely has six months or less to live and is, indeed, terminally ill. The recipient must also sign a statement choosing Hospice Care rather than routine Medicare covered benefits. This is important, since Hospice Care does not cover any curative treatments. Finally, the recipient must receive care from a Medicare-approved hospice program.
To find out more, call your State Hospice Organization, your Regional Home Health Intermediary, or 1-800-MEDICARE. If you or someone you love is terminally ill, sometimes Hospice Care is the best option. Although it doesn’t attempt to cure the illness, it can offer comfort and peace.
Signing up for a Medicare Prescription Drug Plan is one step in ensuring your continued health. Referred to also as Medicare Part D, drug plans are available both through Original Medicare and as part of many Medicare Advantage Plans. Depending on the plan you select and the company you choose, however, your costs can vary significantly.
Most plans will charge a monthly premium. This premium varies according to plan and is in addition to the premium you pay for your Part B coverage. Your costs for specific medications will also vary, depending on the plan you’ve chosen and the drugs you need. Additionally, your costs will be affected by whether or not you get “extra help”. You may qualify for extra help if you have a limited income, and should call Social Security at 1-800-772-1213 to find out.
By having a number of plans to choose from, you will have the opportunity to find the one that best meets your needs. However, in order to effectively utilize your plan, spend time familiarizing yourself with all the costs involved, the specific medications covered, the benefits of switching to a generic drug, and any coverage gaps. People who are fully prepared when using their Medicare Prescription Drug Plan are more satisfied with their coverage and are able to use it most effectively.